Mucormycosis - Pulmonary
Mucormycosis can cause serious life-threatening infection in compromised hosts. While rhinocerebral mucormycosis is the most common form of the disease, mucormycosis can involve the skin, pulmonary, renal, and gastrointestinal organs, or it can disseminate. The underlying risk factor can influence the clinical manifestation; rhinocerebral disease is common in diabetics, whereas patients with hematological malignancies or neutropenia usually have pulmonary disease.
Pulmonary disease typically manifests as cough, dyspnea, and unremitting fever despite broad-spectrum antibiotics. Hemoptysis occurs as a result of tissue necrosis and angio-invasion and, rarely, can be fatal. Physical examination findings are nonspecific and include tachypnea, crackles, decreased breath sounds, and wheezing.
In addition to uncontrolled diabetes mellitus and diabetic ketoacidosis, hematological malignancies, and neutropenia, major risk factors for invasive disease include lymphomas, deferoxamine therapy, and immunosuppression as a result of solid organ and stem cell transplantation. Corticosteroid therapy has been cited as predisposing factors. In patients with human immunodeficiency virus (HIV), mucormycosis is rare, but when it does occur, it can do so without the typical predisposing factors. In patients with HIV / AIDS, mucormycosis tends to occur in intravenous drug abusers, patients with prolonged and severe neutropenia, and individuals with very low CD4 counts. Systemic toxicity can be severe and progress rapidly, or the disease can progress insidiously. Death frequently occurs. Mucormycosis may complicate previous bacterial infection.
In immunocompetent hosts, epidemic mucormycosis has been associated with penetrating and nonpenetrating trauma caused by natural disasters, eg, the tornado in Joplin, MO, in 2011. DNA analysis in that case showed an Apophysomyces trapeziformis species.
For discussion of diseases caused by fungi belonging to the order of Entomophthorales, see Cutaneous basidiobolomycosis, Disseminated basidiobolomycosis, and Rhinofacial conidiobolomycosis.
B46.3 – Cutaneous mucormycosis
76627001 – Mucormycosis
- Ecthyma gangrenosum in patients who are immunocompromised.
- The clinical manifestations of mucormycosis are similar to that of other invasive fungi like Aspergillus, Fusarium, and Pseudallescheria spp. Mucor appears as broad, non-septate hyphae with branches occurring at right angles; rarely, septa may be seen. The other fungi have thinner, septate hyphae with frequent, acute-angled branching.
- Leishmaniasis (Old World and New World)
- Candida sepsis